Inspection on 22/04/09 for Andrin House

This inspection was carried out on 22nd April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Andrin House 01/04/08

Andrin House 02/04/07

Andrin House 19/04/06

Andrin House 05/09/05

Andrin House 18/04/05

Andrin House 27/09/04

Andrin House 05/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Andrin House 43 Belper Road Derby DE1 3EP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Angela Kennedy     Date: 2 2 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Andrin House 43 Belper Road Derby DE1 3EP 01332346812 F/P01332346812 enquiries@andrinhouse.fsnet.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Rosecare Homes Limited Name of registered manager (if applicable) Rowena Cortez Isidro Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: 1 place for named service user (MH) in category PD under 65 years of age.. 1 place for named service user (DG) under 65 years of age. Date of last inspection Brief description of the care home Andrin House is a 37 bedded care home with nursing for older people, situated in a residential area close to the city centre of Derby. The property was originally a private dwelling, which has been extended and converted into a care home. Bedrooms are located on the ground floor and first floor, and are accessed by lift and staircase. Three bedrooms have en suite facilities and there are four communal rooms for the people who use the service, including a room for people living at the home who smoke. Support services are in place with a choice of GPs, chiropodist, dentist and optician. Information provided by the service in April 2009 stated that people funded by the local authority paid the current rate and privately funded fees ranged from £360 a week for residential care to £468.80 for nursing care. Care Homes for Older People Page 4 of 31 care home 37 Over 65 37 0 Brief description of the care home Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The last key inspection undertaken at this service was on the 1st April 2008. This key inspection was unannounced. Key inspections take into account a wide range of information and commence before the site visit by examining previous reports and information such as any reported incidents. The site visit is used to see how the service is performing in practice and to meet with the people using the service. The focus of inspections undertaken by the Care Quality Commission is upon outcomes for people using the service and their views on the service provided. This process considers the providers and registered managers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Care Homes for Older People Page 6 of 31 An Annual Quality Assurance Assessment (AQAA) had been completed by the service. This is a self-assessment for providers which is a legal requirement. This assessment gives the provider and registered manager an opportunity to let us know about their service and how well they think they are performing. The information provided in the AQAA is reflected within this report. At this inspection visit two people were case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at care plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. Neither of the people case tracked were able or wished to express their views of the service and the support it provided. However the views of several people living at the home and their relatives are included within this report. This information was gathered by talking to people and through information that was provided in surveys that were returned prior to this visit. The views of several members of staff are reflected within this report. This information was gathered by talking to staff on duty and through the staff surveys returned prior to this inspection visit. The manager was available for the last hour of this inspection. Prior to this the deputy manager was available to provide any information and documents requested. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs were assessed before admission was agreed to ensure the home was right for them. Evidence: The pre-inspection self-assessment stated that the manager or nurses assessed the needs of individuals prior to admission. The two care files looked at had information about the person taken at the time of admission this included an assessment of their care needs that had been undertaken by a senior member of staff from the home. As both of the people case tracked were funded records were also in place that demonstrated that assessments had been undertaken by the Local Authority. One persons file did not contain a completed description of their interests and Care Homes for Older People Page 10 of 31 Evidence: activities. It was stated that this was because the person was confused and unable to provide this information. Where this is the case this information should be obtained from a third party whenever possible such as relatives and friends. A Map of Life describing both individuals past history was seen. However this information was limited and contained little information about their strengths or achievements. Care Homes for Older People Page 11 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples capacity to make choices and decisions was not assessed appropriately, this means that the level of support they recieve may be compromised and not in their best interests. Evidence: The pre-inspection self-assessment stated that each person had care plans that were person centred. One person case tracked had care plans in place that clearly reflected their needs with regard to personal care and health care. The care plans for this person focused on their needs along with the tasks staff carry out to meet them, there was little information about their abilities and social needs. This means that staff did not have a complete picture of the individual to enable them to provide their care in a person centred and consistent way. For example one care plan instructed the staff to support the person to participate in washing themselves as much as they could. This doesnt tell the staff what the person is able to do for themselves and what they need support Care Homes for Older People Page 12 of 31 Evidence: with. The care plans seen for this person were supported by risk assessments. These assessments identified areas of risk and how these were to be managed, to ensure this persons safety was maintained. All elements of the care plan documents had been looked and evaluated monthly. Records to demonstrate that this persons health care needs were being met was also in place. This included visits by General Practitioners and chiropodists, as well records of hospital appointments. The other person case tracked did have care plans in place that had been regularly reviewed. Although the reviews of care reflected the current non compliance of this person regarding areas of their care, this was not clearly reflected in their care plan. The risk assessments in place for this person had been reviewed regularly and demonstrated that they were at risk in areas such as skin integrity and nutrition. This was being addressed through the use of pressure relieving equipment but the level of personal care this person received meant that staff were not aware of their current skin condition. The health care records demonstrated that this individual refused health care services such as chiropdy and opticians. There was no evidence in place to demonstrate that this persons mental capacity had been assessed to ensure their best interests were being met. There was evidence to demonstrate that a review of this persons needs had been undertaken by the placing authority in July 2008, however the information provided was limited and did not reflect this persons current situation. It was confirmed by the deputy manager that this review had been conducted over the telephone and not in person. Records showed that the other person case tracked had their care reviewed by the Local Authority three months after their admission to determine that they had settled into the service and that their needs were being met. In general the comments made by people using the service and their representatives were positive regarding the standard of care provided. However the comments from one relative did indicate that there was sometimes a conflict between the individual choice of people using the service and the staffs duty of care to ensure individuals best interests were met. This was also evident in the care plans of one of the people case tracked. It is important that each persons capacity to consent is assessed against their best interests and that the care plans and support they receive reflects this. This will ensure that the level of support they require is not compromised. Staff were observed throughout the day and demonstrated a kind and respectful manner when supporting the people using the service. The medication administration records for the two people case tracked were looked at and systems for storage, recording and administration of medicines on their behalf was Care Homes for Older People Page 13 of 31 Evidence: satisfactory at the time of this visit. Handwritten sheets were properly signed and dated, the controlled drugs record was satisfactory and medicines with short life spans such as eye drops were labelled with date of opening and stored appropriately. Clinical fridge temperatures were recorded appropriately to ensure medicines requiring cold storage were stored at the correct temperature. One person chose to self administer their medication. This person kept their medication in safe storage within their personal accommodation and their medication administration record showed that they self administered their prescribed medicines. There was a written disclaimer in place regarding self administration and the manager had recorded on this, that the person had been assessed as competent to self administer their medication. However there was no written assessment in place to demonstrate that this person was able to store and administer their medication safely. Care Homes for Older People Page 14 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Time was made available to ensure peoples social and recreational needs were met. People were supported to maintain contact with family and friends. The quality and variety of meals provided was enjoyed by the people using the service. Evidence: The pre-inspection self-assessment stated that the home continued to hire outside entertainers, take individuals out and keep them stimulated by providing daily activities by the activities coordinator and visits from the vicar on Sundays for communion. Structured activities were available at the home 6 days a week. An activities coordinator was employed for 5 mornings from Monday to Friday. The activities coordinator stated that she felt mornings were better as most people liked to have a nap in the afternoons. The types of activities included group activities such as bingo, ten pin bowling, sponge painting, food tasting, basket ball, playing cards and manicure mornings. The activities coordinator stated that as food tasting had proved popular this is done more often. Care Homes for Older People Page 15 of 31 Evidence: At the time of this inspection the one to one activities were limited to talking books, although on discussion with the activities coordinator it was confirmed that sitting and chatting with individuals or reading the paper to individuals was also undertaken. An external entertainer provided a music and movement session on Saturdays. On Sundays although no structured activities are undertaken the local vicar visited to provide communion to those who wished to join in. It was confirmed that there were some individuals who were visited by the own vicar/ priest. It was also confirmed by the deputy manager that some people visited their preferred church with their family or staff. The activities coordinator confirmed that trips out are organised like going to the park, pub lunches, walks into the town. Records of all of these activities were recorded in the activities diary. Taxis were used if needed, however the activities coordinator confirmed that the home was fund raising to purchase a minibus. It was confirmed that funds were raised through sponsored events such as the one being undertaken by a relative and Fayres at the home such as at Christmas, Easter and in the summer. The records seen demonstrated that activities were planned in consultation with people at the home such as through residents meetings. The activities co-ordinator confirmed that she had has applied to do specialist activity training to develop her skills and knowledge. Comments regarding the activities provided were generally very positive, such as the activities and stimulation is good. One relative indicated that activities were only suitable for those that were able to join in and one person said that more entertainment would benefit the people using the service. This was discussed with activities coordinator and agreed that as activities took place in the mornings it may be that some visitors did not see these activities taking place, although they were written on the notice board. One relative provided lots of suggestions for activities, many of these related to orientation and reminiscence and were discussed with the activities coordinator at this inspection. A hairdresser was available each week on a Monday and a salon was provided in the home . The deputy manager confirmed that no one living at the home used advocacy services and non were advertised within the home. Care Homes for Older People Page 16 of 31 Evidence: Visitors confirmed that they were always welcomed by staff . Observations throughout the day demonstrated that the rapport between visitors and staff was warm and friendly. Staff rotas demonstrated that the kitchen was staffed from 7.30am to 2.30pm. Teatime meals are prepared and left for care staff to hand out. Discussions with the cook confirmed that each day the care staff asked each person what their preferred lunch time meal was. The records showed that there was 2 options each day. The cook did confirm that if neither were liked an alternative could be prepared. The cook confirmed that few people required special diets and was able to explain how specific dietary needs were met. It was observed on the day of this inspection that people were escorted to the dining table forty minutes before the meal was served. This was unfortunate as several people were sitting in the garden prior to lunch, enjoying the good weather and some indicated their disappointment at having to come inside and then wait for their lunch. Comments regarding the meals were generally positive, most people said they enjoyed their meals. One comment was made by a relative that indicated that they were not always confident that people were supported and encouraged to eat. However from observations of the meal time and the records seen it did appear that individuals were supported and encouraged to eat their meals. Staff were observed supporting individuals in a friendly way, the mealtime itself was unhurried and relaxed. Care Homes for Older People Page 17 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Incomplete records meant that peoples concerns may not have been fully addressed. The practices in place and the training provided ensured people were protected from abuse. Evidence: The pre-inspection self-assessment stated that complaints are listened to and acted upon promptly and fairly. It said that all complaints are welcomed and that the service accepted them positively. It also confirmed that the complaints procedure was displayed in the home and that staff were aware of protecting and safeguarding residents and had attended training in safeguarding and that the whistle blowing policy is passed on during staff induction. Records of complaints were in place and demonstrated that five complaints had been made since the last inspection, however the outcomes were not always recorded. In general the actions taken were recorded on most records seen and demonstrated that these complaints had been investigated. Comments within one relatives survey said that they were not always sure that complaints were followed through. As the actions taken, were not recorded on all records seen this makes this statement difficult to determine. Relatives and people using the service confirmed that they were aware of the complaints procedure. One Care Homes for Older People Page 18 of 31 Evidence: person using the service said that if they had any concerns they would either tell their family or the manager. One safeguarding referral had been made about a person that had lived at the home and this was investigated by the local authority and no actions were taken. The home has the Local Authority procedure on Safeguarding Adults and their own policy plus report cards that can be used for recording any evidence of abuse. All of this information was accessible to staff as it was held in the duty office. Staff spoken with were aware of the policy and procedure to follow and training records demonstrated that Safeguarding training was provided to staff through Derby County Council. Records showed that this training had been undertaken in February 2009. Staff comments regarding training included, it was good to do a refresher course, it provided me with a good understanding of the practice to follow. Care Homes for Older People Page 19 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service lived in a well maintained home but some practices of the home could compromise their safety. Evidence: A partial tour of the building was undertaken. It was noted that hand scrub was left on a shelf in the communal lounge. The deputy manager was not able to confirm that this was safe to leave out and that none of the people living at the home may pick this up and use it inappropriately. Cans of airfreshners were in all of the bathrooms seen. Again the deputy manager was not able to confirm that these was safe to leave out. All of these items were removed and placed somewhere secure but accessible to staff. This was done immediately by the house keeping staff on duty. The maintenance room contained numerous tools that could be seen through the small glass window in the door. The door was closed but wasnt locked.This room was at the far end of the corridor away from the communal areas, but had potential if left unlocked to put people using the service at risk. The pre-inspection self-assessment stated that the home is kept clean, warm and well ventilated, equipment is well maintained and serviced regularly. It was also stated that Personal Protective Equipment was used at all times, this is to ensure that infection Care Homes for Older People Page 20 of 31 Evidence: control is maintained. The general appearance of the home was clean and tidy and the standards of cleanliness and hygiene appeared satisfactory. Staff were observed wearing protective clothing, such as disposable aprons when supporting people with personal care. Comments in one relatives survey stated that the bedrooms were not always maintained to a high standard. However on the day of this visit a sample of bedrooms was looked at, at the beginning of this inspection and appeared clean and tidy. A smoke room was available for the people using the service and the door to this room was kept shut to ensure that smoke did not filter to other areas of the home. The laundry room was staffed for five hours a day, each day including weekends. Care staff also attended to additional laundry in the evenings as required. The laundry room housed sufficient equipment to launder clothing and appeared clean and tidy. Care Homes for Older People Page 21 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and skill mix of staff in place ensure peoples support needs can be met. The recruitment practices in place ensure that people are supported by staff that are suitable to care for them. Evidence: The training records seen showed that training in mandatory areas was up to date and that dementia training had been booked for staff. The induction provided to staff was not based on skills for care induction standards and was more of a checklist for staff to undertake at the start of their employment. It was confirmed by the manager that there was no work book for staff to work through. Therefore it was difficult to ascertain how new staff were assessed as competent within their role. As stated in the pre inspection information 97 of the care staff have achieved a National Vocational Qualification (NVQ) at level 2 in care and 2 were working towards NVQ 2 and 3 in care at the time of this visit. This demonstrates that the staff team had the relevant qualification to enable them to enhance the support and care they provide to the people living at the home. Care Homes for Older People Page 22 of 31 Evidence: Staff comments were positive regarding the training and support they received. People using the service and staff spoken with felt that the staffing levels were appropriate to meet individuals needs. A key worker system in place with defined roles and senior carers were assigned specific tasks for staff so that they knew what tasks they were responsible for when on shift. Staff spoken with also confirmed that the staff team worked well together. The staff rotas demonstrated that staffing levels were appropriate to meet the needs of the people using the service. As stated in the pre inspection information the continuity of care had improved as the service now has better staff attendance and agency staff were only used in an emergency. This information was supported by the records seen and discussions held on the day of this inspection visit. The recruitment records for two members of staff were looked at and both had the required documents in place to demonstrate that a thorough recruitment practice was in place at the home. All of the checks and records required by law were in place to ensure the staff employed were safe to care for the people living at the home. As stated earlier in this report staff were observed supporting individuals throughout the day in a friendly and relaxed way. Care Homes for Older People Page 23 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The finances of the people using the service are safeguarded and their opinions are sought and acted upon. The health, safety and welfare of the people using the service is generally well met. Evidence: The registered manager stated that she has almost completed a management qualification and has undertaken training in Deprivation of Liberty and Safeguarding. She confirmed that the deputy manager and another nurse were now booked onto this training. Once this training has been cascaded to all staff they will have a greater understanding of the safeguards that must be in place for any person who is unable to make informed decisions about some or all areas of the care and support they receive because they lack the mental capacity to do. The staff spoken with confirmed that formal supervision sessions were provided on a more regular basis. The evidence seen within the records held demonstrated that staff Care Homes for Older People Page 24 of 31 Evidence: supervision sessions were now provided at frequent intervals. This ensured that the staff team were provided with the support and guidance required to undertake their duties and support people effectively. Staff did say that they were able to go into the office at any time and speak with the manager or deputy if they had any concerns. Records of staff meetings were also in place and these records showed that staff were kept up to date with any issues or change in practice and provided staff with an opportunity to discuss and comment on any issues they had. As stated in the pre inspection information meetings were held every four months for the people living at the home and relatives meetings were also held every four months. Minutes of these meetings were seen. Information showed that purchases / ideas for the home were following the requests of people using the service, such as a karaoke machine, garden furniture and the food tasting activity mentioned earlier in this report. Records showed that people were asked for suggestions for outings and these suggestions were recorded and some undertaken or arranged, such as bowling, mini boat cruises and tips to the theatre. Information was recorded regarding parties and recent events such as valentines party, easter bonnets, raffles and a pantomime that was provided in house by a theatrical group. Relatives comments seen in questionnaire audits were positive and questionnaires were sent out annually and were also available in the reception area. At the last inspection visit it was identified that monthly provider reports were not being completed. These have are now being undertaken but need to be further developed to include routine sampling of the opinions of people living at the home and their relatives/ representatives. The majority of people living at the home had some money that was held in safe keeping for them.Records and receipts were kept of all transactions. The money was held securely and accessible only to the provider. The manager confirmed that if anyone wanted access to their money when the provider was not available a petty cash float was kept and this was used. The manager also stated that any moneys left by relative would be kept in envelope in petty cash tin and a receipt given to the relative or representative. A Sample of service certificates were seen and all were up to date, this included a gas safety certificate, Portable Appliance electrical Tests, hoist service certificates, fire panel service certificates and weekly fire alarm tests. This ensures that the environment remains safe for the people living at the home, staff and visitors. Care Homes for Older People Page 25 of 31 Care Homes for Older People Page 26 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 14 There should be written 22/07/2009 evidence in place to demonstrate that when a person using the service refuses care and support, an assessment of their capacity to make decisions is undertaken by a suitably trained person. This will ensure that the best interests of each person using the service are met. 2 7 12 Each persons capacity to consent should be assessed against their best interests and the care plans and support they receive must reflect this. To ensure the level of support recieved is not compromised There should be written evidence in place to demonstrate that when a person using the service refuses health care services 22/07/2009 3 8 12 22/07/2009 Care Homes for Older People Page 28 of 31 an assessment of their capacity to make decisions is undertaken by a suitably trained person. This will ensure that the best interests of each person using the service are met. 4 16 22 A record of all complaints 22/10/2009 recieved must be maintained and include details of the investigation undertaken, including any actions taken and the outcome of the complaint. This is to demonstrate that all complaints received are fully investigated. 5 19 13 Any substances that could be hazardous to the health and safety of the people using the service must be stored securely. To ensure that the health and safety of those using the service is not put at unnecessary risk. 6 30 18 New staff employed at the home must receive structured induction training. This is to ensure new staff meet the aims of the home, work in a safe way and are able to meet the needs of the people using the service. 22/07/2009 06/05/2009 Recommendations These recommendations are taken from the best practice described in the National Care Homes for Older People Page 29 of 31 Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 14 14 Independent Advocacy services should be advertised to ensure they are accessible to the people using the service. People using the service should not be escorted or asked to sit at the dining table for a meal , until the meal is ready to be served. Regulation 26 visits should be further developed to include routine sampling of the opinions of people using the service and their relatives/ representatives. 3 33 Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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